SWMOA 2019 Annual Symposium Registration – Exhibitor/Sponsor/Host Facility Included Comp SWMOA 2019 Annual Symposium “Increasing Membrane Consciousness: How the Southwest Continues to Improve Membrane Treatment” June 24-26, 2019 – Riverside, CA RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*Job Title*Company*Address*City*State*Zip/Postal Code*Country*Phone*CellEmail*Enter registered attendee's email address Email for billing contactEmail address sent to billing contact, if applicable Attendee materials delivery email optionYes, I would like to have the materials sent to another email addressNo, I would like to have the materials sent to the email aboveAttendee materials will be sent approx. 2 weeks after event, provide an email address compatible to receive and/or access Hightail messages.Attendee materials email address If you prefer to an email other than listed above, provide the email address here. Website Need Contact Hours Certification?*Yes, need contact hours certificationNo, Contact Hours reqiuredLicense #*License State*License Type*License Grade* Special Needs Food Allergies (describe in comments) Gluten Free Meals Halal Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe in Comments) Communication and Data Sharing PreferenceSWMOA has been diligent in Data Security and being compliant with US and other Nations regulations in sharing your contact information as well as receiving email communications from SWMOA on upcoming events and other resources.I would like to receive email messages from SWMOA about Events, Newsletter or Activities*YesNoAuthorization for receiving publication email notification from SWMOA.(applies to all email addresses on this form)I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared*YesNo Member (check all that apply) SWMOA AMTA Event RegistrationEarly Registration applies to registrations received by May 24, 2019.Today - Date Registration*Full Symposium - Members, Comp.Full Symposium - Non-Members, Comp.Full Symposium - Speaker/Full-Time Student/Retired, Comp.One Day Only - Tuesday, Comp.Half Day Only - Monday, Comp.Half Day Only - Wednesday, Comp.Purchase Materials Only - Cannot Attend, $30Members/Affiliates must be from the list above.Students must be full-time and must submit ID.Will you be staying at the Host Hotel: The Mission Inn Hotel & Spa?*Make your lodging arrangements directly with the The Mission Inn Hotel & Spa by phone at 951-784-0300 ext. 850/800-843-7755 and refer to SMO06222019 for the discounted room rate. Make your reservations by May 24, 2019 for the discounted rate.Yes, I will be staying at the host hotelNo, I will not be staying at the host hotelHow many nights will you be staying at the Host Hotel: The Mission Inn Hotel & Spa?* Upload Company LogoAccepted file types: jpg, gif, png, pdf.Company Description*100-word company description Symposium AttendeeIf different from above.Salutation - Exhibit Attendee*Mr.Mrs.Ms.Dr.First Name - Exhibit Attendee*Last Name - Exhibit Attendee*Job Title - Exhibit Attendee*Company - Exhibit Attendee*Address - Exhibit Attendee*City - Exhibit Attendee*State - Exhibit Attendee*Zip/Postal Code - Exhibit Attendee*Phone - Exhibit Attendee*Email - Exhibit Attendee* Included RegistrantSalutation - Included Registrant*Mr.Mrs.Ms.Dr.First Name - Included Registrant*Last Name - Included Registrant*Job Title - Included Registrant*Company - Included Registrant*Address - Included Registrant*City - Included Registrant*State - Included Registrant*Zip/Postal Code - Included Registrant*Phone - Included Registrant*Email - Included Registrant* Event ActivitiesNetworking Reception: Mission Inn Hotel*Yes, Attending Networking ReceptionNo, not Attending Networking ReceptionMon., Jun. 24 - 4:30-5:30 p.m.Included in your registration fee.Guest/Spouse Attending Network Reception: Mission Inn Hotel?*Yes, Guest/Spouse Attending Networking Reception, $35No, Guest/Spouse Not Attending Networking ReceptionGuest/Spouse Attending Network Reception: Mission Inn Hotel?*Yes, Guest/Spouse Attending Networking Reception, $45No, Guest/Spouse Not Attending Networking ReceptionFacility Tours*Yes, Attending Facility ToursNo, Not Attending Facility ToursTues., Jun. 25 - 1:15-4:15 p.m.Networking Event: Baseball Game*Yes, Attending Networking EventNo, not Attending Networking EventTues., Jun. 25 - 6:00-10:00 p.m.Included in your registration fee.Guest/Spouse Attending Network Event: Baseball Game?*Yes, Guest/Spouse Attending Networking Event, $35No, Guest/Spouse Not Attending Networking EventGuest/Spouse Attending Network Event: Baseball Game?*Yes, Guest/Spouse Attending Networking Event, $45No, Guest/Spouse Not Attending Networking Event Total Registration FeeTotal Registration Fee $0.00 Payment InformationPayment Method*Complimentary Registration Only - No Optional Items SelectedCredit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check, make payable to: Southwest Membrane Operator Association, and mail to: 1035 E. Vista Way. #103, Vista, CA 92084. CommentsIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentIf yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.Name* First Last Email Address* Comments or Instructions Written cancellation requests received by SWMOA on or before May 17, 2019 will receive a refund, less a 25% processing fee. Full payment is required if cancellation is received on or after May 18, 2019 - no refunds and no credits for future events will be granted. However, substitutions may be made at any time. SWMOA reserves the right to make changes in programs and speakers, or to cancel programs when conditions beyond its control prevail. Every effort will be made to contact each enrollee if a program is cancelled. If a program is not held, SWMOA’s liability is limited to the refund of the program fee only. toward the scheduled event. Final Step of Application ProcessCAPTCHAPlease enter the letters displayed above to complete your application and then click Submit.